Archive | November, 2014

Report from Mexico

24 Nov

The Missing 43: Adding to the current woes of the world, and as has been reported in the US media, Mexico is undergoing a crisis that has the potential to become a watershed event in its modern history. It has been more than eight weeks since the disappearance (and now presumed death) of 43 students in the State of Guerrero, an event that has galvanized the populace against the government. The demand to find the students and punish those responsible has broadened into anger about corrupt politicians, drug traffickers, poverty, injustice, etc. It has unveiled a deep distrust of government and protests have spread far beyond the State of Guerrero. While the original protests were peaceful and specifically related to the 43, many of the subsequent demonstrations have turned violent. As has happened in other places, peaceful protests sometimes turn violent when joined by “outside agitators”; substantial property damage has been reported. Last Thursday was Revolution Day, commemorating the 104th anniversary of the Mexican Revolution of 1910, and tens of thousands of protesters marched on the capital. In recent days I have been in receipt of numerous “emergency messages” from the American Embassy in Mexico City alerting Americans of the time and anticipated locations of the myriad demonstrations – and also reminding us that the Mexican constitution prohibits political activity by foreigners. Interestingly, unlike the United States, there has been no “live” coverage of these events and subsequent media coverage has been sparse. The media is a concession awarded by the government to its friends so whatever coverage there is tends to be pro-government. At the same time the President is under fire for awarding a high-speed rail contract to a Chinese firm after it was revealed that the firm in question owns the home in which the President resides. Our friends Andres and Karen, who now reside in Mexican City, were our house guests for several days this past week and it was interesting to talk to them about all of these matters. Although they have somewhat differing views, neither believe these events will lead to any significant change. Although San Miguel generally stays above the fray, the current unrest is evident even here in the signs and posters all around the Parroquia, as illustrated by the following photo (which translates “we are all students”):


Mexican Medical Care: A frequent conversation among expats is medical care, especially given that most expats in San Miguel are, or are soon to become, Medicare-eligible. The underlying and abiding hope inherent in these conversations is that Congress will pass legislation allowing Medicare benefits to be paid to medical providers outside of the U.S.; after all, medical costs in Mexico are a fraction of what they are in the United States. My view is that it will never happen. Not only is the AMA opposed to such an idea, but Medicare fraud is rampant in the US; imagine how difficult it would be to monitor fraud in a foreign country, especially a country known for corruption. Still, the conversation goes on and is interspersed periodically with seminars offered by a variety of service providers, not only offering various forms of medical insurance but emergency evacuation plans (“SkyMed”), etc. Some opine that paying for the remote possibility that one would need to be evacuated by air is silly; after all, one can just buy a ticket on an airline. However, airlines only allow you to board if your condition is deemed “stable” so someone who is seriously ill might not be allowed to fly on a commercial airliner. In addition to issues like insurance, many expats are wary of medical care in Mexico, believing it to be inferior to that available in the United States. From anecdotal conversations around the dinner table, it appears that is a legitimate complaint for some — but as is true around the world, it all depends on the doctor.

As for me, until recently I have had little exposure to medical care in Mexico, having visited a doctor only three times in the nearly three years I have lived here, twice in search of antibiotics and the third time to the dermatologist for a checkup. Incidentally, until fairly recently one did not need a prescription for most drugs, psychotropic drugs being the exception, to which antibiotics have been added. Yet many other drugs only available with a prescription in the United States are available here over-the-counter.

So early on a Monday morning in September I went to see Dra. Blanca, a well-regarded dermatologist in San Miguel, for a routine checkup. Although I used to have periodic checkups in the States, I have never had a dermatologist who took such care, going carefully through my scalp, inspecting between my toes, etc.   I had no concerns so was surprised when the doctor told me she wanted to do two biopsies on my face. A few days later she called to say that one of the biopsies was melanoma.  On reflection, I shouldn’t have been surprised. A California girl, I spurned the use of sun screen and when a teenager, would sometimes lather on the baby oil for a day at the beach. I’ve never liked hats and have generally been cavalier about sun protection. Initially I was inclined to return to the States for the surgery, especially in light of the potential costs, most of which would have been covered by Medicare. Before making such a decision, however, Dra. Blanca recommended that I meet with an oncologist and she referred me to Dr. Rodrigo d’Obaldia who has a thriving practice in Queretaro, 45 minutes away, but has weekly office hours in San Miguel.

IMG_1246 He spent an hour and a half with us and charged 500 pesos for the consultation ($37 USD). We were sufficiently impressed to schedule the surgery for the following week here at the hospital in San Miguel. In preparation for surgery I first had a chest x-ray (300 pesos/$22 USD) and an untrasound of my neck to check for metastasis (558 pesos/$41 USD), as well as complete blood work (717 pesos/$53 USD). All were negative. One of the interesting things about Mexican medicine and quite unlike the U.S., the patient receives all of the reports including x-ray film, slides from the pathologist, etc.

The melanoma was high on my left cheek, next to my nose and just under my eye so the surgery was delicate, requiring a skin graft from lower on my cheek. In addition to Dr. Obaldia, there was a second surgical oncologist (one on each side of me). The operating room appeared to be quite modern and since I elected to have only local anesthetic, I was fully conscious for the entire operation lasting just short of two hours. My lack of proficiency in Spanish denied me the opportunity to listen to the on-going conversation between the two surgeons but their soft voices were comforting sounds and I retreated to a zen-like state. The melanoma was removed and the pathologist reported that I have what is known as “clear margins” meaning the tissue surrounding the melanoma was free of cancer cells. The surgical fee was 15,000 pesos ($1,108 USD) and the hospital charge for the operating room was 6,493 pesos ($480 USD). Amazing. I can only imagine what the cost might have been in the U.S. Although there was some possibility that the scar would require plastic surgery at a later date, I am pleased to report that the scar is barely noticeable so I will be unable to use any of the elaborate stories I had concocted to explain it. I can’t say enough about the exceptional care that I have received – and have been amazed at the personal, follow-up care of both doctors. Dra. Blanca must have called me at least a dozen times to inquire after my well-being and any concerns I may have harbored about medical care in Mexico have been alleviated.  Indeed, I can’t imagine having received any better care any where in the world.  Since my surgery I have had two bad colds; I’m told any type of surgery can suppress the immune system although the reasons for this are not fully understood.

The Baby Shower: Through Andres and Karen we have met many interesting people including Matteo and Noemi.  Matteo, a Mexico City chef with a glowing reputation has been named executive chef at a very high-end restaurant in San Miguel and he and his wife Noemi have moved to San Miguel.  Noemi is from Switzerland and the two of them met in Milan, Italy, where both were studying.   They are a wonderful addition to our circle of friends and are expecting their first child next month. With some encouragement we decided to host a baby shower for Noemi.



The Future: There is a part of me that thinks that this blog is in its waning days. I have reported on nearly every event that populates the Mexican calendar and can now only repeat myself. But then something happens to dissuade me. Like the morning that a solo trumpeter walked up our street, by himself, playing jazz – an exceptional trumpeter playing exceptional music. Or the guy selling roasted corn on the cob that comes by every evening calling out “Elote” in a musical cadence. And not too long ago Karen took me out in the campo (the countryside) to watch a woman make tortillas from scratch for her family – with only a wood fire – but I’ll save that story for yet another day.  In the meantime, we remember the 43: